Hierarchical Condition Category (HCC) Coding Specialist

About the role

This job will deliver value to the Health Plan, and its beneficiaries enrolled in Risk Adjusted government programs such as Medicare Advantage (MA) and Affordable Care Act (ACA), using skills including but not limited to Hierarchical Condition Category (HCC) Coding, medical coding, clinical terminology and anatomy/physiology, Centers for Medicare and Medicaid Services (CMS) coding guidelines, and Risk Adjustment Data Validation (RADV) Audits. Works closely with physicians, team members, Quality, Compliance, partners at Enterprise and leadership to identify and deliver high quality and accurate risk adjustment coding.

Responsibilities

• Performs HCC coding on projects for MA, ACA, and End Stage Renal Disease (ESRD).
• Flexes between coding projects, including Retro and Prospective, with different MA, ESRD, and ACA HCC Models; works independently in various coding applications and electronic medical record systems to support departmental goals.
• Adheres to CMS Guidelines for Coding and Highmark’s Policy and Procedures to guide HCC coding decision making.
• Maintains RPM coding accuracy and productivity requirements.
• Assists with Regulatory Audits by performing first coding review and ranking of charts.
• Builds partnerships and works within coding teams and internal partners critical to HCC coding.
• Participates on ad-hoc projects per the direction of Leadership to address the needs of the department.
• Provides recommendations for process improvements and efficiencies.
• Engages in RPM Coding educational meetings and annual coding Summit.
• Other duties as assigned.

Qualifications

• Required: None
• Preferred: Associate degree in medical billing/coding, health insurance, healthcare or related field preferred.

Skills

• Critical Thinking
• Attention to Detail
• Written and Oral Presentation Skills
• Written Communications
• Communication Skills
• HCC Coding
• MS Word, Excel, Outlook, PowerPoint
• Microsoft Office Suite Proficient
• MS365 & Teams

Benefits

Not specified

Pay

Minimum $27.02 Pay Range Maximum $41.85 Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Schedule

Remote Office-based Teaches / trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Occasionally Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required No Lifting up to 10 pounds Constantly Lifting 10 to 25 pounds Occasionally Lifting 25 to 50 pounds Rarely